Gastrointestinal disorders, consisting of gastroparesis, abdominal distension, irritable bowel syndrome and fecal incontinence, are common in individuals with type 1 diabetes (T1D)(1993). Indeed up to 80% of individuals with long-standing T1D, who are generally affected by several diabetic complications including end stage renal disease (ESRD) (1993; Atkinson et al., 2013; Fiorina et al., 2001), show intestinal symptoms. The presence of these gastrointestinal symptoms, known as diabetic enteropathy (DE), significantly reduces the quality of life (1993; Atkinson et al., 2013; Camilleri, 2007; Talley et al., 2001) and has a largely unknown pathogenesis (Feldman and Schiller, 1983). Preclinical studies showed significant derangement of the intestinal mucosa morphology in diabetic rodents (Domenech et al., 2011; Zhao et al., 2003), suggesting that in T1D intestinal homeostasis may be altered; however, little data are available in humans. The intestinal epithelium is maintained by intestinal stem cells and their niche, which respond to physiological stress and to environmental injury (Barker, 2014; Medema and Vermeulen, 2011). Colonic stem cells (CoSCs), located at the crypt base of the large intestine and expressing the ephrin B receptor 2 (EphB2), leucine-rich repeat containing G protein-coupled receptor 5 (LGR5), h-TERT and aldehyde dehydrogenase (Aldh), among other markers (Carlone and Breault, 2012; Carpentino et al., 2009; Jung et al., 2011; Sato and Clevers, 2013), constitute with the local microenvironment the CoSC niche (van der Flier and Clevers, 2009; Zeki et al., 2011). Recent studies have established conditions that recapitulate many features of intestinal homeostasis and generate normal self-renewing large crypt organoids in vitro, or so-called “mini-guts” (Sato and Clevers, 2013). Whether systemic factors, such as circulating hormones, serve to control the CoSCs remains to be established (Stange and Clevers, 2013).
The treatment of gastrointestinal disorders, in particular diabetic enteropathy, includes symptomatic drugs and reliever medications for diarrhea, abdominal pain, constipation, and dyspepsia. Up to date there is no specific treatment available for diabetic enteropathy. The diagnosis of gastrointestinal disorders, in particular diabetic enteropathy includes colon endoscopy, gastric endoscopy, anorectal manometry, esophageal manometry and analysis of fecal samples, evaluation of peripheral cancer markers (i.e. CEA, Ca 19.9, alpha-fetoprotein, Ca125) and of celiac markers. None of the aforementioned method is capable of providing a certain diagnosis of diabetic enteropathy.
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